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BMJ Open. 2020 Sep 06;10(9):e035111. doi: 10.1136/bmjopen-2019-035111.

Association of coronary revascularisation after physician-referred non-invasive diagnostic imaging tests with outcomes in patients with suspected coronary artery disease: a post hoc subgroup analysis.

BMJ open

Takao Kato, Yukari Uemura, Masanao Naya, Naoya Matsumoto, Mitsuru Momose, Satoshi Hida, Takao Yamauchi, Takatomo Nakajima, Eriko Suzuki, Moriaki Inoko, Tohru Shiga, Nagara Tamaki


  1. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan [email protected].
  2. Department of Data Science, National Center for Global Health and Medicine Hospital, Shinjuku-ku, Tokyo, Japan.
  3. Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine School of Medicine, Sapporo, Hokkaido, Japan.
  4. Department of Cardiology, Nihon University Hospital, Chiyoda, Tokyo, Japan.
  5. Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Toyo Medical Research Center, Shinjuku-ku, Tokyo, Japan.
  6. Department of Cardiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
  7. Cardiovascular medicine, Japan Community Healthcare Organization Sagamino Hospital, Sagamihara, Japan.
  8. Department of Cardiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan.
  9. Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine School of Medicine, Sapporo, Hokkaido, Japan.
  10. Heart Center, Kitano Hospital, Osaka, Japan.
  11. Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

PMID: 32895263 PMCID: PMC7476491 DOI: 10.1136/bmjopen-2019-035111


OBJECTIVE: We aimed to evaluate the association of the prognostic impact of coronary revascularisation with physician-referred non-invasive diagnostic imaging tests (single photon emission CT (SPECT) vs coronary CT angiography) for coronary artery disease.

DESIGN: A post hoc analysis of a subgroup from the patient cohort recruited for the Japanese Coronary-Angiography or Myocardial Imaging for Angina Pectoris Study.

SETTING: Multiple centres in Japan.

PARTICIPANTS: From the data of 2780 patients with stable angina, enrolled prospectively between January 2006 and March 2008 in Japan, who had undergone physician-referred non-invasive imaging tests, 1205 patients with SPECT as an initial strategy and 625 with CT as an initial strategy were analysed. We assessed the effect of revascularisation (within 90 days) in each diagnostic imaging stratum and the interaction between the two strata.

PRIMARY AND SECONDARY OUTCOME MEASURES: Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalisation for heart failure and late revascularisation, were followed up for 1 year. The χ

RESULTS: A total of 210 (17.4%) patients in the SPECT stratum and 149 (23.8%) in the CT stratum underwent revascularisation. Although in each stratum, the cumulative 1 year incidence of MACEs was significantly higher in patients who underwent revascularisation than in those who did not (SPECT stratum: 9.1 vs 1.2%, log-rank p<0.0001; CT stratum: 6.1 vs 0.8%, log-rank p=0.0001), there was no interaction between the risk of revascularisation and the imaging strata (SPECT stratum: adjusted HR (95% CI), 4.25 (1.86-9.72); CT stratum: 4.13 (1.16-14.73); interaction: p=0.97).

CONCLUSION: The association of revascularisation with the outcomes of patients with suspected coronary artery disease was not different between SPECT-first and CT-first strategies in a physician-referred fashion.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: coronary heart disease; coronary intervention; ischaemic heart disease; nuclear radiology

Conflict of interest statement

Competing interests: None declared.


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